Gender Nonconformity and Research

As transgender visibility grows in the mainstream, more and more people are learning who transgender people are and what it means to be trans. However, transgender is not an identity that is easily defined. The Trans Youth Equality Foundation (TYEF) has a list of sexual/gender identities and their definitions on its website. TYEF broadly defines transgender identity as one that doesn’t “conform to conventional notions of the sexes male and female,” like an umbrella term for gender nonconformity. The TYEF list also includes identities like nonbinary. While these identities can overlap with identifying as transgender, all three identities are different and distinct; not all people who identify as nonbinary also identify as transgender, for example, and vice versa.

However, public health researchers often lump nonbinary (along with many other gender identities) within the umbrella of transgender in research studies [1]. Moreover, public health researchers may even use categories that result in erasure of transgender identity. Although this practice has been changing, transgender women have often been grouped with cisgender men under the category of men who have sex with men [2]. What does this mean for public health research and the knowledge about transgender people that is being produced?

Generally speaking, it means that the data and conclusions that researchers make about transgender people may miss these important distinctions in identity, especially as these distinctions affect gender nonconforming people’s health. For example, one qualitative study of nonbinary people showed that there may be gatekeeping within trans communities, and that nonbinary people who also identify as trans may not feel “trans enough” to access transgender health services [3]. Moreover, the medical and public health focus on “binary transgender people” (i.e. transgender people who identify as men or women, rather than nonbinary) may actually contribute to the erasure and invisibility of nonbinary people and their stigmatization in healthcare and research settings [4]. Thus, when using transgender as an umbrella term, researchers may be missing barriers to healthcare and other health risks that uniquely affect nonbinary people.

However, public health research on transgender people has continually been changing as some researchers look towards solutions for more nuanced data [5]. Notably, a two-step questionnaire design allows researchers to ask participants about both their sex assigned at birth and gender identity. Thus, rather than simplifying identities under a transgender umbrella, these solutions accept their complexities and allow participants more agency in defining themselves in the research process. In so doing, researchers may be more able to look at health inequalities between different gender identities that they have previously missed.